A nurse is preparing to perform a fundal massage for a postpartum client who is experiencing uterine atony. In which order should the nurse plan to perform the following actions?
Ask the client to lie on her back and with her knees flexed.
Position one hand around the top of the client's fundus and one hand just above the client's symphysis pubis.
Rotate the upper hand to massage the client's uterus while using slight downward pressure to compress the fundus.
Observe the client's perineum for the passage of clots and the amount of bleeding.
The Correct Answer is A, B, C, D
The correct answer is A, B, C, D.
The nurse should plan to perform the following actions in this order:
A. Ask the client to lie on her back and with her knees flexed.
B. Position one hand around the top of the client’s fundus and one hand just above the client’s symphysis pubis.
C. Rotate the upper hand to massage the client’s uterus while using slight downward pressure to compress the fundus.
D. Observe the client’s perineum for the passage of clots and the amount of
bleeding.
Fundal massage is performed to stimulate uterine contractions and prevent
postpartum hemorrhage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The nurse should demonstrate how to hold the newborn and allow the client to
practice.
This will help the mother learn how to properly hold her baby and feel more confident in her ability to care for her newborn.
Choice A is not the best answer because insisting that the mother pick up the
newborn to feed him may make her feel uncomfortable or pressured.
Choice C is not the best answer because persuading the client to breastfeed the newborn to promote bonding may not be appropriate if the mother has chosen to botle-feed her baby.
Choice D is not the best answer because offering to take the newborn to the nursery to finish his feeding may not address the mother’s concerns about holding her baby.
Correct Answer is C
Explanation
Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that can result in dehydration, weight loss, and ketosis.
Clinicians suspect hyperemesis gravidarum based on symptoms and can support the diagnosis by measuring urine ketones.
Choice A, Rapid plasma reagin, is a blood test used to screen for syphilis.
Choice B, Prothrombin time, is a blood test that measures how long it takes for blood to clot.
Choice D, Urine culture, may be indicated because urinary tract infection is common in pregnancy and can be associated with nausea and vomiting.
However, urine ketones would be a more specific test for hyperemesis gravidarum.
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